insurance and enbrel

[carl7777]

Hi..
Been going the round the world battle with the insurance demons and the answer that I get from them is that my insurance does not cover injectables.........My medical plan will cover it on a 20% basis, my cost.......I know this is very expensive stuff and I can't afford lots of up front money and hope to wait for the insurance Company to repay it in their own sweet usual time. I am guessing that my cost per month for the enbrel will be 200-300 dollars, my portion.......is this about right and is anyone out there haveing to go thios route????.....Is there help out there for us poor folks. I have Pa and P and as I said they , my insurance, medical has approved it but my Prescription insurance will not pay for injectables........Is there a way arround the 1000-1200 dollar up front money.....need help bad cause 75% covered and getting worse daily.....HELP>>>HELP>>>>>PLEASE....I have sit here for a couple hrs now reading all the boards and anything that will help me , let me know...This is a wonderful site and I can tell there is some really special people here because only those who live with this curse can truely understand the heart ache...Thanks

[chaimFL]

Hey Carl.....

Sorry to hear about the insurance problems!! There are only 2 ways around insurance that I know of.....

(1) http://www.needymeds.com which is a website that can provide drugs at a lower cost or even perhaps free, but you have to do some paperwork and prove the financial burden......the process can be time consuming.

(2) Contact the drug maker directly and ask about special programs that they may offer. Many drug makers have programs that provide the drug directly at reduced cost or once again sometimes free if financial burden is proven.

The only other option I can think of is to find clinical trials in your area that are testing either Enbrel, Humira, or Remicade (all good for P and PA).

[makeitgoaway]

You can also enlist the help of the NPF. They have some great folks on staff willing to try and help.

[MikeK]

Hi Carl,

I'm sorry that you're going through such a rough time. :( Chaim and Steve both gave you great advice. Chaim's suggestion that you contact www.needymeds.com and/or the makers of Enbrel is a great idea. Www.needymeds.com sounds like a scam site, but several people have posted here that they've been helped by it. The makers of Enbrel have insurance specialists on Staff, which can help people deal with insurance issues. Here's a link: http://www.enbrel.com/enliven/enbrelenliven-expert.jsp. Finally, Steve's suggestion that you contact the NPF is another gread idea. The NPF has an Insurance Advocacy Service, which also helps people deal with insurnace issues. Here's a link to a description of the service: http://www.psoriasis.org/medical/advocacy/ and here's a the NPF"s contact informatin:

National Psoriasis Foundation
6600 SW 92nd Ave., Suite 300
Portland, OR 97223-7195
Phone: (503) 244-7404 OR (800) 723-9166
Fax: (503) 245-0626
E-mail: getinfo@psoriasis.org

Their regular business hours are Monday through Friday, 8:00 a.m. to 5:00 p.m. Pacific Time.

Hope this helps.

Good luck. Feel better. Keep us posted and please don't be a stranger.

Mike

[PJ Leary]

Hi Carl,

Welcome to the site. You got the big guys right off the bat. Both Mikek and Chaim are right, and gave you excellent advice. I have nothing to add.

Excpet, keep coming here and let us help any way that we can. We're a good sort, helpful and nice, with much experience in dealing with all aspects of this disease.

[cdelora]

Hi Carl

I had the same problem that you are having. My Rhuemy finally persuaded the ins co to pay for Enbrel under major medical. If all else fail you might try this. They pay 90% Enbrel is expensive at $1350 per month. But each ins program is different. It took five months to get the ins co to agree.

Good luck and keep on trying enbrel has really helped.:) :) :) :)